19th June 2007

THE HUMAN, SOCIAL AND FINANCIAL COSTS OF MRSA:
                                                  
CONFERENCE REPORT.

MRSA and Families Network hosted a conference in the Edmund Burke Theatre at Trinity College, Dublin, on the 19th June, 2007. The theme of the conference was “The human, social and financial costs of MRSA”. The conference was ably chaired by The Hon. Mr. Justice Hugh O’Flaherty, who informed the audience that he was also there to learn from the contributors. The conference was well attended by MRSA casualties, health care professionals, solicitors and people involved in the manufacture and sale of anti-bacterial products.

MRSA and Families Network members graphically described the human and social cost of hospital acquired infections. Margaret Dawson, who is also the founder of the organization, spoke of how MRSA had changed the life of her husband, Joe, for ever. It has also robbed Margaret of a lively, able partner, and her children of active father.

Tony Kavanagh told the moving story of how the pain caused by an MRSA infection took him to the gates of hell, and almost quenched his will to live. He will not take up full time employment again. Noeleen Friel described how her son, Ronan, was deprived of his independence and livelihood when he acquired MRSA. The care of Ronan has impacted on Noeleen and her husband, and they worry about what will happen to him in the future.

Dr. Betsy McCaughey, founder of the American organization ‘Reduce Hospital Infections’ (RID), and former Lieutenant Governor of New York, told the conference that the technology and expertise to eradicate at least 90% of hospital acquired infections already exists. However, the will to enforce the necessary measures is lacking.

Countries like Holland, Denmark and Finland faced up to the problem twenty years ago and brought their infection rates down to under 1%. They did this by enforcing rigorous hand hygiene and meticulous cleaning of equipment between patient use. Dr. McCaughey also stressed the importance of screening patients to identify those carrying the drug resistant bacteria.

This regime is known as the ‘Search and Destroy’ method in Holland. Dr. McCaughey cited research which shows that this method has worked where it has been applied in the US. Among the example cited were: The University of Virginia  which eradicated MRSA between 1980 and 1882, and the U Pittsburg Presbyterian Hospital where MRSA was reduced by 90% in the ICU using this method. Most astonishingly, at the Allegheny Hospital, Dr Richard Shannon reduced central line blood stream infection by 90% in just 90 days. He was expected to reduce these infections by 10% or 20% over several years.

Dr. McCaughey told the conference that most hospital administrators say that they cannot afford to put the necessary screening and cleaning into place. She stressed that hospitals can’t afford not to take these precautions. Apart from costing lives, hospital infections are adding millions of dollars in America, and Euros in Ireland, to the cost of the health care system. Dr. McCaughey presented research evidence which shows that preventing hospital infections is cost effective. As well as saving lives, infection prevention is also saving money.

If this is not incentive enough to motivate hospital administrators to prevent infection, Dr. McCaughey said that the threat of litigation will add to the pressure. She maintains that in the US, hospital infections are going to be the next asbestos in the courts. Dr. McCaughey finished her most informative presentation by giving us 15 steps that should be taken to prevent infection before a prospective patient goes into hospital, and by looking forward to co-operation across the Atlantic between her organization and MRSA and Families Network. 

Dr. Ian Hosein, Director of Infection Prevention and Control, Cardiff and Vale NHS Trust presented his Holistic approach to the prevention of MRSA. Dr. Hosein has reduced the incidence of MRSA by over 70% in the hospitals under his control by quality systems management. He doesn’t have huge resources or sufficient infection control staff at his disposal, but, he told the conference, he works by empowering every worker in the hospital to take responsibility for doing the job correctly.

He asks the staff members to tell him what they need, and he supplies it if he can. He maintains that staff are unhappy and worrying about job cuts or strikes, then they cannot concentrate on what they need to be doing. Dr. Hosein puts the patient at the core of the service, and feels that if all the staff are doing the right things for the patient, then the outcome, including infection control will be positive.

It is the job of management, according to Dr. Hosein, to ensure that the hospital works properly by ensuring that the staff are able to do their work. Sr. Hosein is passionate about his work, and communicated to the audience that the hospital, its staff and its patients are all part of the same community.

Mr. Paul Bergervoet, an Infection Control Practitioner from Deventer Hospital in Holland is an exponent of the ‘Search and Destroy’ policy which was so lauded by Dr. McCaughey. It is the only system he has known in his working life and it works. Mr. Bergervoet explained the system to the audience, and said that in Holland, they have identified two groups in the population whose members need to be screened on entering hospital. One such group contains people who have been in a hospital abroad during the last two months, and the other contains pig farmers.

By screening and isolating such patients, infection is prevented in Dutch hospitals. While Mr. Bergervoet said that it would be impossible to say what it would cost to setup such a system from scratch, he was able to estimate what it costs now. In an overall annual budget of €107 million in his hospital, the Search and Destroy policy costs €25,057, which he feels is peanuts.   He also presented evidence from Spain where the search and Destroy policy was introduced in a hospital where it was shown that if only four patients were prevented form getting an infection, the program was cost effective.

Dr. Angela Rossney, Chief Scientist at he National MRSA Reference Laboratory in Dublin, compared the conventional methods of detecting MRSA with the new Rapid Detection machine. She described how sample are taken and what happens in the lab. Using the conventional methods, it takes from three to five days to get a result. This has implications for isolating and treating the patients.

The Rapid Detection machines can give a result using DNA techniques in under one hour. However, Dr. Rossney pointed out, the best of these machine has, at present, an accuracy of in excess of 90%, so more validation has to be done. She and her colleagues are engaged in this work at the moment, but she said, in order to carry out the research more resources and staff are needed. Dr. Rossney said that this has been apparent for some time now, and no effective action has been taken.

Mr. John Scurr, who is Consultant General and Vascular Surgeon, Lister House, The Lister Hospital, Chelsea and trained in the legal aspects of report writing, giving evidence in court and in the responsibilities of a Single Joint Expert, told the conference about the inevitability of litigation.

  In clear and concise terms, he described the kinds of infection which occur, and how they occur, and why patients bring legal claims. He mentioned one claim which was settled out of court in Britain, and estimated that there are going to be considerable costs accruing to the Irish State down the road. He also spoke of the proliferation of managers in the NHS in Britain.

He estimates that there is one manger for every patient in hospital and enough left over to populate Wilshire. He suspects that there may be a similar over supply of managers in Ireland, while other areas of clinical care and infection prevention are neglected. 

Mr. Ian Simon, solicitor and legal advisor to MRSA and Families, told the conference about the mammoth task facing anybody bringing a legal case in Ireland as a result of hospital acquired infections. He spoke of the difficulty of getting the hospitals to supply the necessary documents under the Freedom of Information Act, and the time wasted on appealing when such documents are not forthcoming.

Mr. Simon laid out the other strategies being adopted by him to further the cases of his clients. The description of MRSA as a hazardous substance, the non-enforcement of the 1995 SARI guidelines, and the existence of the 1947 Health Act, which describes allowing infection to be spread from patient to patient as a criminal act, were included in his presentation.

MRSA and Families Network are extremely grateful to all who presented papers at the conference, all who attended, the reporters and photographers, and the conference staff at Trinity College who all contributed to the success of this conference.